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Van Buren County United Way
This form may be used, however, we will email you a printable copy if requested, as the budget page is different from the one displayed here. Applications must be mailed and recieved prior to the deadline date of the quarter you are applying for. Mail or drop off your application to Van Buren County United Way, 181 W Michigan Ave. , Suite 4, Paw Paw, Michigan 49079. If you have questions you may call Vera E Tanier, Executive Director at 269-657-2410.
Van Buren County United Way
Request for Funds
Applications are received two times a year. Only one Mini-Grant award per calendar year is allowed per agency. Please check the Grant period for which you are applying:
1st Grant Period ________ 2nd Grant Period _______
Name of Organization: ___________________________________________________
Contact Person: _________________________________________________________ Telephone: _______________________________ Fax No.: ______________________ E-Mail: __________________________________________ Mailing Address of Organization or Group: __________________________________ __________________________________ __________________________________ Project Title:____________________________________________________________ Project Start Date: ________________________ End Date: _____________________ End of Project Report Due 30 days following end date: _________________________ Amount Requested: ______________________________________________________ Signature of person authorized to bind organization:
________________________________________ __________________
______________________________________________________ Van Buren County United Way Mini-Grant 2010
NON- United Way Agencies ONLY
Attach one copy of the following:
Most recent Audit (or alternative)
Most recent Financial Statement 501 (c) 3 Determination Letter Most recent IRS Form 990 Current Roster of Board Officers and Directors (include the Board member's affiliations, work place & job position) Most recent Michigan License to Solicit Charitable Contributions Statement of Human Service Mission within Van Buren County
Grant Application Process:
Application 1st Grant Period 2nd Grant Period
Deadline 3 p.m. January 8th July 9th Award Notification February 5th August 6th
Availability of Funds: Applications will be reviewed by an Independent Review Committee selected from your Partner Agency peers and will change each Grant Period. The scoring system points are as follows: 1. Purpose, Rationale, Need, Target, and Impact: (20 pts)
II. Project Plans: (20 pts) IV. Innovative and Creative Features: (10 pts) V. Sustainability and Replicability: (15 pts)
VI. Budget Page: (20 pts)
Van Buren County United Way Mini-Grant 2010 Application Instructions
The purpose of the VBCUW Mini-Grant Program is to provide flexible grant opportunities to United Way Partner Agencies and Non-United Way Agencies (must be a 501c3 operating in Van Buren County) for programs and services not necessarily part of the community impact priorities and general allocation process.
The United Way Mini-Grant Program funds can be utilized for the following opportunities:
1. Seed Money
Seed Money is often needed by agencies to get a new program started in a community. This seed money could also serve as matching funds that attract and leverage other funding for the new program. This would be a one-time grant for the particular program.
2. Special Projects
This could include a new program or event, special training for staff and/or community, needs assessment, strategic planning, emergency situations, marketing development, well-defined consultation needs, and infrastructure development.
3. One-time equipment needs
Equipment, special software, equipment failures/emergencies, medical equipment and office equipment are often needed by agencies but budget restrictions prohibit such purchases.
The VBCUW Mini-Grant Program will not fund: construction of facilities, building improvements, agency shortfalls, lobbying activities, grants to individuals, fellowships, general operating expenses (i.e. salaries, fund raising, or capital campaigns) of an established organizations.
Eligible Applicants:
Ø
Non-profit organizations (501c3 or equivalent) serving Van Buren County or areas of Van Buren County.
Ø
United Way Partner Agencies (Partner Agencies have priority and will score additional points for that status on the grant application scoring system).
Ø Non-United Way Agencies.
Mini-Grant Application Form
1. Purpose, Rationale, Need, Target, and Impact (20 points possible) A. What need(s) will this project address? Explain the significance of the needs. B. Who is the project intended to benefit? C. What is the estimated number of recipients/families who will benefit from the project? Include both direct and indirect benefits, if any. D. Explain the intended impact. List the goals of the project. II. Project Plans: Explain how the project will achieve the desired outcomes identified above in section (D). (20 points possible) A. Describe the activities that will be implemented in order to achieve each of the goals/objectives in (D) of section one. For each activity, please include (i)its start and end dates, and (ii) lead person(s) responsible for conducting the activity/project. B. Briefly explain any barriers to the project implementation that still remain unresolved as of the application submittal date, e.g. need for additional funding beyond the amount requested from VBCUW, outstanding participation commitments from other parties, need to secure commitment of space or other resources. III. Evaluation Plan (15 points possible) A. Describe how progress toward each of the project objectives will be assessed. Evaluation methods should be clearly related to these objectives. IV. Innovative and Creative Features (10 points possible) A. In what ways does this project address a need in a new, creative or innovative fashion? V. Sustainability and Replicability (15 points possible) A. What is your strategy for sustaining this project after the grant period? If not sustainable, what is the project's potential impact beyond the grant period? B. What is the potential for replicating this project elsewhere in Van Buren County? VI. End of Project Report Due A. An end of the project report must be filed within 30 days of the end date of your project when receiving United Way Mini-Grant funds. These reports are filed after being reported and reviewed by the VBCUW Board.
Van Buren County United Way
Mini-Grant Application
Proposed Budget 2010
(20 points possible)
Budget Item and Cost Formula Proposed Activity Description Estimated Cost
Grant Request Other funding sources requested or secured Total
1. Training, needs assessment, seed monies - itemized: $ $ $ 2. Travel related to project: $ $ $ 3. Outside services, e.g., speaker, consultant: $ $ $ 4. Non-Capital items (materials, transportation, food, printing, etc.) List itemized costs individually: $ $ $ 5. Other (please describe) $ $ $ 6. In-Kind contribution or matching funds - please detail: No point deduction if this is N/A $ $ $ Totals: $ $ $ |